Abstract P341: Poor Childhood Dental Care: A Risk Factor for the Development of Coronary Artery Disease and Potential New Target for CAD Prevention

Background: Accumulating evidence supports a relationship between periodontal disease (PD) and coronary artery disease (CAD). The mechanism of the increase in CAD among PD patients is thought to involve chronic inflammation resulting from PD. As a result, the American Academy of Periodontology recommends screening for CAD in patients with severe PD. In the present study we hypothesized that preventive dental care in childhood would be associated with reduced CAD in adulthood, and that this effect would be independent of traditional CAD risk factors. Methods: Patients (n=223) at a single dental clinic were invited to answer a questionnaire regarding present CAD and PD disease as well as risk factors for CAD. In addition, a detailed history of childhood dental care was obtained. Results: Ninety-one patients (41%) had CAD and 72 (32%) had PD. Significantly more patients with PD reported a history of CAD vs. those without PD (51% vs. 29%, p=0.002). Patients who reported a history of regular dental checkups and prophylaxis as children had significantly less CAD compared to those without regular childhood dental care (24% vs. 54%, p<0.001). In contrast, there was no difference in prevalence of CAD among patients who reported regular dental brushing in childhood vs. those who did not (33% vs. 40%, p=NS), suggesting that professional dental prophylaxis was required for achievement of a CAD-protective effect. In a logistic regression model, poor childhood dental care remained strongly associated with CAD even the traditional risk factors of smoking, hypertension, and male sex were controlled for. The relationship between childhood dental care and CAD did not appear to be wholly explained by the occurrence of PD in patients with poor dental care: even in patients without PD, childhood dental care remained associated with reduced CAD (20% with dental care vs. 43% without dental care, p=0.002). Conclusions: Poor childhood prophylactic dental care is a potential new risk factor for development of CAD. Screening for poor dental care in addition to traditional risk factors may add to the assessment of CAD risk, and including dental education and intervention in programs targeted to reduce CAD risk factors in adolescents may impact on the incidence of CAD in adults.